Provider Demographics
NPI:1730323098
Name:PROMED OF SWEETWATER
Entity Type:Organization
Organization Name:PROMED OF SWEETWATER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMIERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-220-9700
Mailing Address - Street 1:10740 W. FLAGLER ST. SUITE #4
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-1415
Mailing Address - Country:US
Mailing Address - Phone:305-220-9700
Mailing Address - Fax:305-554-6088
Practice Address - Street 1:10740 W. FLAGLER ST. SUITE #4
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-1415
Practice Address - Country:US
Practice Address - Phone:305-220-9700
Practice Address - Fax:305-554-6088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-29
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC9183261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFI422AMedicare PIN